Policies and programs that promote abstinence as the only option for unmarried adolescents are scientifically and ethically flawed, states an article co-authored by a faculty member in the University of North Carolina Gillings School of Global Public Health.

Dr. Ilene Speizer

The article, “Abstinence-Only-Until-Marriage: An Updated Review of U.S. Policies and Programs and Their Impact,” was published online Aug. 22 by the Journal of Adolescent Health. Ilene S. Speizer, PhD, research professor of maternal and child health at the Gillings School and a faculty fellow at the Carolina Population Center, is a co-author.

In the article, Speizer and colleagues updated findings from a 2006 review of abstinence-only-until-marriage (AOUM) policies and programs promoted by the United States government. Their new review highlights changes that have occurred in that time, including revisions to AOUM funding and programs, as well as new evidence about the impact of AOUM programs on public health in general and adolescents in particular.

Review research involved collecting and analyzing reports from educators, policymakers, government sources and human rights organizations, as well as conducting a review of new academic literature.

As the article’s abstract notes, “Adolescence is marked by the emergence of human sexuality, sexual identity and the initiation of intimate relations; within this context, abstinence from sexual intercourse can be a healthy choice. However, programs that promote abstinence-only-until-marriage […] are scientifically and ethically problematic and – as such – have been widely rejected by medical and public health professionals.”

The core concern with AOUM, the researchers state, is that – while abstinence is effective in theory – it often fails in practice. This failing is exacerbated by the fact that, given a globally rising age at the time of first marriage, the number of young people remaining abstinent until marriage is in decline.

The U.S. government promotes and funds AOUM policies both nationally and through foreign aid programs. The weight of scientific evidence, however, has found that AOUM programs are not effective in delaying the initiation of sexual intercourse or changing other sexual risk behaviors. (In comparison, many comprehensive sexuality education programs do successfully delay intercourse and reduce risky behaviors.)

In addition to ignoring other birth-control options, AOUM programs withhold information about human sexuality and often provide medically inaccurate and stigmatizing information. The review also found that, in many U.S. communities, AOUM programs have replaced more comprehensive approaches, effectively undermining the effectiveness of sexuality education.

By limiting young people’s access to accurate and comprehensive sexual health information, the researchers conclude, AOUM programs threaten fundamental human rights to health, information and life.

“This paper is particularly timely given that the Trump administration recently canceled future funding for 81 projects that are part of the Teen Pregnancy Prevention Program (TPPP),” Speizer said. “The TPPP supported evidence-based strategies to reduce teen pregnancy; these strategies included comprehensive education approaches that met the needs of all young people. Unfortunately, there is a real risk that the progress represented by TPPP will now be undone in a return to government support of abstinence-only education. This is a poor choice, as our review demonstrates.”

An accompanying position paper by The Society for Adolescent Health and Medicine also was published online Aug. 22 in the Journal of Adolescent Health.

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